Market Reform and Policy Issues for Implementation of Health Reform in North Carolina TAG Meeting #7 - Pre Meeting Webinar July 26, 2012
Discussion Roadmap � � Project Goal, Webinar Objectives and Value Statement � Update on Federal and State Actions � Topics for Phase II Consideration and Input � Topics for TAG Discussion and Input in TAG #7 � Next Steps
Project Goal and Meeting Objectives � Project Purpose: Develop policy options and considerations and identify areas of consensus to inform the NC DOI actions and recommendations for Exchange-related market reform policies. (pursuant to North Carolina Session Law 2011-391) “It is the intent of the General Assembly to establish and operate a State-based health benefits Exchange that meets the requirements of the [ACA]...The DOI and DHHS may collaborate and plan in furtherance of the requirements of the ACA...The Commissioner of Insurance may also study insurance-related provisions of the ACA and any other matters it deems necessary to successful compliance with the provisions of the ACA and related regulations. The Commissioner shall submit a Objectives for Today’s Meeting report to the...General Assembly containing recommendations resulting from the study.” -- Session Law 2011-391 � Outline parameters of broader discussion to be addressed at in-person meeting, including update on relevant Federal guidance/initiatives � Initiate TAG thinking and solicit input regarding Phase 2 topics for discussion � Begin to discuss if select certification requirements should apply outside the Exchange market � Network Adequacy Requirements with a focus on essential community providers, mental health providers and overall regulations � Enrollment Rules/Regulations in the individual market
Statement of Values to Guide TAG Deliberations � The TAG will seek to evaluate the market reform policy options under consideration by assessing the extent to which they: • Expand coverage; • Improve affordability of coverage; • Provide high-value coverage options in the HBE; • Empower consumers to make informed choices; • Support predictability for market stakeholders, competition among plans and long-term sustainability of the HBE; • Support innovations in benefit design, payment, and care delivery that can control costs and improve the quality of care; and • Facilitate improved health outcomes for North Carolinians.
Discussion Roadmap � � Project Goal, Webinar Objectives and Value Statement � Update on Federal and State Actions � Topics for Phase II Consideration and Input � Topics for TAG Discussion and Input in TAG #7 � Next Steps
Federal Actions and Reports � Cooperative Agreement to Support Establishment of Supreme Court Decisions on the ACA the ACA’s Health Insurance Exchanges June 2012 June 2012 • Divided court ruled that it is constitutional for individuals to have • Provides States with financial assistance for the establishment insurance or pay a tax penalty and that States have an option to of State-operated health insurance exchanges, including expand Medicaid without loss of existing federal funding. “Level One” and “Level Two” Establishment grants. Draft Blueprint for Approval of Affordable State-based General Guidance on Federally-facilitated Exchanges and State Partnership Insurance Exchanges Released May 2012 Released May 2012 • Detailed information on the federally run Exchanges • Outlines the process and requirements for States to that will be implemented in States where State-based seek certification of State Based Exchanges (SBEs) and Exchanges are not in operation. State Partnership Exchanges. A Review of Federal Guidance/Initiatives Will Be Provided During the In Person Meeting
State Actions and Reports � Examining the Impact of the PPACA in North Carolina North Carolina General Assembly May 2012 May-July 2012 •Written response from the convening of “stakeholders and •Pursuant to Section 49 of S.L. 2011-391, the NC DOI other interested people to examine the new law and ensure submitted a report on May 14th to the NCGA which that the decisions the State makes in implementing the ACA outlines the recommendations from the study of serve the best interest of the State as a whole.” “insurance-related provisions of the Affordable Care Act (ACA) and any other matters it deems necessary to successful compliance with the provisions of the ACA regulations.” •No discussion was formally raised on ACA implementation, including Exchanges, during the session. Source: North Carolina Institute of Medicine, Examining the Impact of the Patient Protection and Affordable Care Act in North Carolina. Morrisville, NC: North Carolina Institute of Medicine; May 2012
Five Core Functions of Exchanges � Consumer support assistors; education and outreach; Navigator management; call Consumer Assistance center operations; website management; and written correspondence with consumers to support eligibility and enrollment. Plan selection approach (e.g., active purchaser or any willing plan); collection and analysis of plan rate and benefit package information; issuer monitoring and oversight; Plan Management ongoing issuer account management; issuer outreach and training; and data collection and analysis for quality. Accept applications; conduct verifications of applicant information; determine eligibility for enrollment in a Qualified Health Plan and for insurance affordability Eligibility programs; connect Medicaid and CHIP-eligible applicants to Medicaid and CHIP; and conduct redeterminations and appeals. Enrollment of consumers into qualified health plans; transactions with Qualified Health Enrollment Plans and transmission of information necessary to initiate advance payments of the premium tax credit and cost-sharing reductions. Financial User fees; financial integrity; support of risk adjustment, reinsurance, and risk corridor Management programs. Source: CCIIO
Three Exchange Options for States � *Coordinate with Medicaid and CHIP Services (CMCS) on decisions and protocols Partnership Exchange can be a way station to a State-based Exchange or a long term allocation of responsibilities. Source: CCIIO, Draft Blueprint for Approval of Affordable State-based and State Partnership Insurance Exchanges . Source: CCIIO, Draft Blueprint for Approval of Affordable State-based and State Partnership Insurance Exchanges.
Exchange: Key Dates � Summer 2012: Publish regulations on 2014 insurance reforms. Oct 1 2013: Dec 31 2014: 2014 Exchanges Proposed open Sept 30 2012: Deadline to select must be self- enrollment begins. benchmark Essential Health Benefits plan. sustaining (1 yr after Jan 1 2014: operation for late Nov 16, 2012: Request developing exchanges.) Exchange goes live.. federal certification for Exchange operations. 2012 2013 2014 July 1 2013: Finalize Aug 15, 2012: QHP contracts. First of ten new opportunities Oct. 2014: to apply for Last Exchange Exchange Establishment Jan 1 2013: Receive grants. application deadline. conditional or full exchange certification from Secretary.
Discussion Roadmap �� � Project Goal, Webinar Objectives and Value Statement � Update on Federal and State Actions � Topics for Phase II Consideration and Input � Topics for TAG Discussion and Input in TAG #7 � Next Steps
Past Project and Regulatory Timeline �� Where we are today Work Streams TAG Discussions & Briefs – Tier 1 Policy Decisions TAG Report Delivered to NCGA on May 14 th 1/1 2/1 3/1 4/1 5/1 6/1 7/1 2013 & 2012 beyond NC Leg. Activity NCGA Legislative Session (May 16 – July 3) Federal Guidance and Activity Development of a Federal Exchange Planning Testing Recent Relevant Guidance Already Issued EHB Bulletin • Establishment of Exchanges and Qualified Draft Blueprint for SBEs EHB Data Collection (Dec. 2011) Health Plans; Exchange Standards for and Partnerships; Standards and QHP Employers Final and Interim Final Rules Guidance on FFEs Accreditation Final (March 2012) (May 2012) Rule (July 2012) • “3R’s” Reinsurance, Risk Corridors & Risk Adjustment Final Rule (March 2012) • Medicaid Eligibility Changes under the ACA Final Rule (March 2012) • Health Insurance Premium Tax Credit Final Rule (March 2012)
Future Project and Regulatory Timeline �� Where we are today TAG Discussions & Briefs – Tier 2 Policy Work Streams and Operational Decisions Development of Risk Adjustment & Reinsurance Plan (as applicable) 7/1 8/1 9/1 10/1 11/1 12/1 1/1/2013 2013 & 2012 beyond NC Leg. Activity NCGA Legislative Session starts in Federal Guidance and Activity January 2013 Development of a Federal Exchange Planning Testing Key Upcoming Dates Sept 30; Nov 16; Request Jan 1; Receive Deadline to federal cert. for conditional/ full Select EHB Plan Exchange ops. Exchange cert. Relevant Guidance Forthcoming EHB Regulations (TBD) 2014 Insurance “3R’s” More Details (TBD) User Fee for FFE (TBD) Market Rules (soon)
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